“A simple blood test can rapidly and accurately detect mutations in two key genes in non-small cell lung tumors, researchers at Dana-Farber Cancer Institute and other institutions report in a new study – demonstrating the test’s potential as a clinical tool for identifying patients who can benefit from drugs targeting those mutations.
“The test, known as a liquid biopsy, proved so reliable in the study that the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) this week became the first medical facility in the country to offer it to all patients with non-small cell lung cancer (NSCLC), either at the time of first diagnosis or of relapse following previous treatment.
“NSCLC is the most common form of lung cancer, diagnosed in more than 200,000 people in the United States each year, according to the American Cancer Society. An estimated 30 percent of NSCLC patients have mutations in either of the genes included in the study, and can often be treated with targeted therapies. The study is being published online today by the journal JAMA Oncology.”
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“The FDA has fully approved the Ablatherm high-intensity focused ultrasound device for the nonsurgical and noninvasive treatment of localized prostate cancer, according to a press release from the device’s manufacturer.
“Ablatherm high-intensity focused ultrasound (EDAP TMS), or Ablatherm HIFU, is recommended for men with localized prostate cancer (stages T1-T2) who are not candidates for surgery, who prefer an alternative option or who failed radiotherapy treatment.
“The device targets the tumor via a computer-controlled rectal probe. Ultrasound waves are intended to destroy the prostate tissue while sparing surrounding organs. Data have indicated the device is effective for prostatic tissue ablation with a low occurrence of side effects, according to the press release.”
“Biodesix, Inc. today announced the launch of GeneStrat™, a targeted liquid biopsy mutation test for genotyping tumors of patients with advanced non-small cell lung cancer (NSCLC). The blood test results are available within 72 hours, providing physicians actionable diagnostic information prior to making treatment decisions. GeneStrat is focused exclusively on the clinically actionable EGFR, KRAS, and BRAF mutations often used to guide targeted therapy treatment decisions. GeneStrat also captures the EGFR T790M mutation, which can be used for monitoring the emergence of the primary resistance mutation in the EGFR gene. It is anticipated that two drugs targeting the resistance mutation may be available later this year. GeneStrat uses the ddPCR platform to analyze cell-free tumor DNA and is highly concordant with tissue analysis, currently considered the gold standard.
“Roughly 30% of lung cancer patients either have insufficient biopsy tissue or are not candidates for a biopsy for tumor mutation profiling. Even in cases where tissue biopsy is available, the sense of urgency to treat is great, with one recent study showing that one out of four patients begin cancer treatment before receiving mutation test results. Requiring only a blood draw, GeneStrat offers a fast, minimally invasive alternative to a high-risk tissue biopsy or re-biopsy in patients with insufficient tissue.
“In addition to providing a minimally-invasive source of mutation status, liquid biopsy can be more cost-effective than traditional tissue biopsies. The mean cost of each tissue biopsy is $14,634 across all patients. The cost of a tissue biopsy can be up to four time higher in the 19.3% of patients who have complications associated with the biopsy. GeneStrat liquid biopsy can help avoid the cost and complications of repeat tissue biopsy.”
“Overall survival rates for resectable stage I non-small cell lung cancer (NSCLC) might improve if treated with stereotactic ablative radiotherapy (SABR) rather than lobectomy, the current standard of care, reports a phase III randomized U.S.-Dutch study led by researchers from the University of Texas MD Anderson Cancer Center in Houston.
“Furthermore, SABR is better tolerated.
“The findings, published in The Lancet Oncology, on May 14, 2015, are the first available data from randomized trials comparing SABR and invasive surgery with mediastinal lymph node dissection or sampling. Nonrandomized studies have previously suggested that SABR might be as effective as surgery, but these results are the first randomized data.
” ‘For the first time, we can say that the two therapies are at least equally effective, and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,’ said principal investigator Joe Y. Chang, MD, PhD, a professor of radiation oncology, in an MD Anderson media release. ‘This study can give physicians confidence to consider a noninvasive option.’ “
“When a suspicious lesion shows up in the lungs on a CT scan, the first thing your doctor wants to know is whether it’s cancerous. A specialist will pass a long, thin bronchoscope into your airway in the hope of grabbing a few cells of the growth so they can be examined under a microscope.
“But some of these lesions or nodules are deep in the small branches of the lungs, out of reach of the bronchoscope, which is about the diameter of a pen. Other times, the results are inconclusive. That has left only two ways to determine whether the abnormality is cancerous: inserting a needle through the chest wall and into the tumor, or surgically opening a patient’s chest to find it (and remove it if necessary).
“The first procedure carries a 15 percent risk of collapsing a lung (pneumothorax), as well as infection. The second is serious surgery that requires general anesthesia and results in the loss of lung tissue. Both are in-patient procedures that carry the cost and other risks of hospitalizations. In about a third of the surgeries, the growth turns out to be benign, meaning the surgery was unnecessary.
“A new type of blood test is starting to transform cancer treatment, sparing some patients the surgical and needle biopsies long needed to guide their care.
“The tests, called liquid biopsies, capture cancer cells or DNA that tumors shed into the blood, instead of taking tissue from the tumor itself. A lot is still unknown about the value of these tests, but many doctors think they are a big advance that could make personalized medicine possible for far more people.
“They give the first noninvasive way to repeatedly sample a cancer so doctors can profile its genes, target drugs to mutations, tell quickly whether treatment is working, and adjust it as the cancer evolves.
“Two years ago, these tests were rarely used except in research. Now, several are sold, more than a dozen are in development, and some doctors are using them in routine care.”
“The genetic fingerprint of a metastatic cancer is constantly changing, which means that the therapy that may have stopped a patient’s cancer growth today, won’t necessarily work tomorrow. Although doctors can continue to biopsy the cancer during the course of the treatment and send samples for genomic analysis, not all patients can receive repeat biopsies. Taking biopsies from metastatic cancer patients is an invasive procedure that it is frequently impossible due to the lack of accessible lesions. Research published October 10th in the journal Breast Cancer Research suggest that tumor cells circulating in the blood of metastatic patients could give as accurate a genomic read-out as tumor biopsies.
“Counting the number of circulating tumor cells (CTCs) can tell us whether a patient’s cancer is aggressive, or whether it is stable and responding to therapy,” says the article’s first author Sandra V. Fernandez, Ph.D., assistant professor of Medical Oncology at Thomas Jefferson University. “Our work suggests that these cancer cells in the blood also accurately reflect the genetic status of the parent tumor or its metastases, potentially giving us a new and easy to source of genomic information to guide treatment.”
The gist: Certain women with lobular neoplasia may not have to undergo surgery to remove it. Lobular neoplasia is a breast condition that indicates a higher risk of later breast cancer. Lobular neoplasia is often removed by surgery. But new research says that with a careful approach, women with classic lobular neoplasia may be treated effectively with observation and possibly drugs to prevent breast cancer. These women can avoid the potential risks of surgery.
“Surgical excision of classic lobular neoplasia diagnosed on calcification-targeting core biopsy can be avoided when careful imaging and pathology correlation is applied, according to results of a prospective study presented at the Breast Cancer Symposium.
“ ‘Lobular neoplasia, including atypical lobular hyperplasia or lobular carcinoma in situ (classic type), is a known pathologic marker of bilateral risk for subsequent breast cancer,’ Barbara Susnik, MD, of Virginia Piper Cancer Institute in Minneapolis, told HemOnc Today. ‘The management of lobular neoplasia identified on core biopsy is controversial, in that recommendations are not established and practices vary. We identified a subset of patients who can avoid surgical excision: patients with lobular neoplasia identified on stereotactic core biopsy, who presented with calcifications on mammography.’
“Susnik and colleagues analyzed 13,772 percutaneous breast core biopsy procedures performed between June 2008 and December 2013.”
Editor’s note: Oncologists can look for cells that have broken off of a primary or metastatic tumor in the blood of a cancer patient to figure out specific characteristics of the patient’s disease. New research shows that routine blood tests for these cells (known as “circulating tumor cells,” or “CTCs”) could help an oncologist track a patient’s cancer over time, revealing information about which treatments might work best.
“Circulating tumor cells captured with a microchip-based device developed at the Massachusetts General Hospital (MGH) Center for Engineering in Medicine and the MGH Cancer Center can be cultured to establish cell lines for genetic analysis and drug testing. In the July 11 issue of Science, an MGH research team reports that the cultured cells accurately reflect a tumor’s genetic mutation over time and changing susceptibility to therapeutic drugs.
” ‘We now can culture cells from the blood that represent those present in metastatic deposits, which allows testing for drug susceptibility as the tumor evolves and acquires new mutations,’ says Shyamala Maheswaran, PhD, of the MGH Cancer Center, co-senior author of the Science paper. ‘We need to improve culture techniques before this is ready for clinical use, and we are working on doing that right now.’ “